Eosinophilic esophagitis (EoE) is an immunologic- chronic, antigen-mediated esophageal disease considered as an emergent condition. Several risk factors have been identified for its phenotypic expression. It seems that ambient factors (clime, allergens derived from regional flora and fauna, dietary elements) acting over genetic susceptibility (race) are important patho physiological factors of this condition. It results in important differences in prevalence in diverse regions of the world. It seems that in the north of Europe and America this disease is more prevalent. Nevertheless it is possible that this condition may be more frequent in these regions because it is more recognized in differential diagnosis of esophageal diseases.
Eosinophilic esophagitis is not prevalent. In my experience in endoscopic cases with esophageal symptoms also is not prevalent. I have seen a few cases in my practice, and most of cases with suspicious endoscopy have biopsy results other than eosinophilic esophagitis.
Eosinophilic esophagitis is still seen rarely, but I havn't seen any case of eosinophilic gastroenteritis.
There were a few cases of eosinophilic esophagitis diagnosed in our insititute though it was still rare compared with eosinophilic gastroenteritis. Endoscopy with biopsy and sometimes EUS or esophageal manometry may help to diagnose eosinophilic esophagitis.
The main objective of the question is to share experience in detection of eosinophilic esophagitis (EoE) in all over the world. It is interesting to observe that only in some few countries, large amount of patients are reported. Even an increase in prevalence and incidence has been observed in those countries. In regions where this disease is low prevalent or not observed it is possible that it is not adequately recognized (esophageal biopsies are not performed in high or moderate risk patients)(1). It means that EoE is under diagnosed in some regions of the world?.
In the other side esophageal EUS nor manometry are not helpful for diagnosis of EoE. Even endoscopic findings have low sensitivity for diagnosis. Esophageal biopsy is the only way to diagnose esophageal eosinophilia (> 15 eosinophils/HPF) and the non cliinico-pathological response of this condition to proton pump inhibitors confirm the diagnosis of EoE.
1.- Garcia-Compean D, Gonzalez Gonzalez JA, Marrufo Garcia CA, et al. Prevalence of eosinophilic esophagitis in patients with refractory gastroesophageal reflux disease symptoms: a prospective study. Dig Liver Dis 2011;43:204–8.
Eosinophilic esophagitis is still seen rarely but It should be searched (2 biopsies in the proximal esophagus and 2 biopsies in the distal esophagus irrespectively of the mucosal finding) in all children with PPI dependent/resistant GERD, food impact and dysphagia with negative X-ray of the esophagus.
It is very important to involve pathologist to obtain multiple section of the biopsies to avoid sampling errors. Eosinophils are frequently found in isolated clusters.
Another important point is to exclude esophageal PPI-responsive eosinophilia performing endoscopy under standard dose of PPI for at least 4 weeks.
Yes, probably EoE is an underestimated entity in some centers all over the world.
In my clinical practice I do about 5-8 new diagnosis of EoE per year. I usually perform 500 EsophagoGastroDuodenoscopy for different indications per year.
in my center we perform 600 EGDS/year with 4 diagnosis/year of the EoE.
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